Putin brings back mental ward torment

Putin brings back mental ward torment

THE elderly couple did not hesitate to open the door when they saw Dimitry Mukhin through their spy-hole. Mukhin, a psychiatrist who lived in the neighbouring building, had recently paid a friendly visit to ask if they needed anything. But this was no courtesy call.

As Emilia Tomareva and Albert Uzikov let him into the Moscow flat where they had lived for decades, Mukhin rushed in with two men in white coats and a policeman.

The shocked couple were bundled into an ambulance with their hands tied behind their backs and locked up in separate psychiatric hospital wards, even though neither was mentally ill.

Both were injected with drugs against their will and without a court order that is normally required under Russian law. By the time they were released 10 days later after a judge ruled that they should never have been incarcerated in the first place, both were ill and terrified.

Uzikov, a leukaemia sufferer, was so weakened by the drugs that he had to be carried home. A few months later he died.

"I don't know what they did to my husband but he could barely stand when he was released," Tomareva said. "We found out that while he was being held he had several minor heart attacks but was not given any medical attention. That, coupled with the drugs they gave him, killed him.

"We lived peacefully and never bothered anyone. What they did to us was criminal. I live in fear now."

Tomareva and Uzikov were victims of what human rights activists are warning is a return to the Soviet-era abuse of psychiatry as a tool of repression.

The Soviet Union routinely silenced dissidents by putting them in asylums. The practice attracted worldwide condemnation, in part because of the protests of Andrei Sakharov, the nuclear physicist confined to the city of Gorky for years.

Among the most notorious cases was that of Alexander Yes-enin-Volpin, a mathematician who became one of the Soviet Union's first dissidents. He was interned in mental hospitals eight times and was once held for two years before he left in 1972 for the United States.

But whereas under communism people were subjected to debilitating drugs because of their opposition to the state, a bribe often suffices now to have a rational person with no interest in politics condemned to the nightmarish world of Russian mental hospitals.

The activists say that rampant corruption, coupled with a lack of controls on Russian psychiatry, have resulted in people being locked up illegally, sometimes simply because someone wants to take over their flat.

Tomareva suspects that some neighbours were behind her detention. She told investigators they wanted to buy the flat in which she and her husband lived but the couple had refused to part with it.

She suspects the neighbours paid a bribe to have them detained with the intention of arranging for their flat to be put up for sale ï¿½ under Russian law, a person found to be mentally ill loses most of their rights.

In the end a court found Mukhin guilty of having sent the couple to a psychiatric ward illegally and gave him a four-year suspended sentence. He denied any wrongdoing.

"Having a perfectly sane person locked up in a psychiatric institution has become shockingly easy," said Tatyana Mal-chikova of the Citizens' Commission for Human Rights, which believes there are hundreds of cases like that of Tomareva.

"All it takes is a bribe. The system is being abused all the time. But whereas in Soviet times the victims were mainly dissidents, now it could happen to anyone over a simple dispute. Once someone sane is locked up and being injected daily with powerful drugs, it doesn't take long to turn them into vegetables."

Last week authorities in the Arctic city of Murmansk released Larissa Arap, an opposition journalist whose five-week detention in two psychiatric hospitals caused a storm of protest.

Arap, who is a supporter of Garry Kasparov, the former chess champion turned fierce Kremlin critic, was confined after publishing an exposé in which she described how staff at a mental hospital were abusing young patients, often with electric shocks. During a routine medical test to renew her driving licence, she was asked by a doctor if she had written the article. Arap defended her story. The doctor called the police and had her forcibly detained. In hospital she was regularly given drugs and last week she was so feeble that she could barely speak.

"I feel very sick," said Arap, who has never suffered from anything more than mild depression. "I have no idea what they gave me but I have memory loss. I lost all sense of time and can't remember much of what they did to me. They tied and beat me. It was torture. I saw other perfectly sane people inside."

Similar treatment was used against Sergei Ablamsky, a lawyer in Bryansk, 250 miles southwest of Moscow, when he came into conflict with a prosecutor he accused of corruption. Ablamsky was taken in handcuffs to a psychiatric institute where he was held for four weeks.

"It was a terrifying experience," he said. "Once you're inside you are no one. You have no rights and are treated worse than an animal. I saw people being beaten up all the time. I was kept drugged and had little understanding of who I was and where I was being held. I could barely move. Once you are trapped inside that world, they will do everything to break you and make you insane." "The Soviet practice of doing away with people by declaring them mentally ill is making a comeback in today's Russia," said Vladimir Bukovsky, a Soviet-era dissident now living in London who was twice locked up in mental institutions.

"Abuse of psychiatry had ceased after the collapse of communism. But now, under Vladimir Putin, a president who has brought back many Soviet-era practices and has described the collapse of the Soviet Union as a catastrophe ï¿½ it's becoming common again."

FTAC ...psychiatry & police collude to control

'I've given you the chance to help, but you haven't. Now someone is going to have to die'

From the assassination of Sweden's foreign minister Anna Lindh to the massacre in Dunblane, the final trigger for some of the most notorious murders was a cry for help that fell on deaf ears. Now, a new cop-and-doc squad is intercepting - and rehabilitating - the deranged loners whose 'end-of-the-road' letters might spell someone else's death sentence. David Rose reports

The handwritten letter, sent to the office of a prominent Tory MP, had a chilling finality. 'I've given you the chance to help, but you haven't,' it said. 'Now someone is going to have to die.'

Its author, a man from the north of England, had written to other high-profile politicians in the preceding months, claiming that the government owed him £300bn for acts of 'criminal negligence' perpetrated by Freemasons, and pleading for their assistance. Later, he claimed that the same MPs had betrayed him, by arranging a coded attack on him to be published in a national newspaper: 'People have died for less,' he wrote.

The man had not yet committed a crime nor made a specific threat to kill. His letters suggested there were grounds to fear for his sanity, but he had never been seen by anyone from his local mental health services. But there was good cause to feel uneasy.

According to consultant psychiatrist David James, one of the world's leading experts in this unusual field, many people who write such 'end of the road letters' may never do anything dangerous. Others will take steps to confront the recipients of their messages face-to-face, if only to embarrass them. Some, however, will attempt to carry out their threat - of murder or assassination. And in the past, some have succeeded.

Assessing the risk and providing treatment to those who may pose it might look like an urgent necessity, but until last year there has been no facility in Britain to deal with such cases systematically. Now it exists: a central unit to which all unsolicited and potentially worrying letters to royals and 'protected politicians' are sent, read and evaluated, as well as examples of bizarre or threatening behaviour at 'iconic locations' such as Downing Street or the royal palaces.

FTAC, the Fixated Threat Assessment Centre, looks unprepossessing: a simple, open-plan office with blue industrial carpet in a stucco town house opposite Buckingham Palace. But its appearance is deceptive, for FTAC represents a new and radical departure - the first ever specialist squad that brings together a full-time complement of mental health professionals with the police, funded jointly by the Department of Health and the Home Office. (FTAC's officers are drawn from London's Metropolitan police, but it has national responsibilities.)

This month, The Observer Magazine was given exclusive access to FTAC and its staff. David James - whose research helped to found the centre, and who now co-directs it - outlines its mission: 'We have discovered that letters written to prominent individuals can be a powerful tool in detecting people suffering from untreated psychotic illness,' he says. But FTAC isn't just about preventing murders that haven't yet occurred, and is much less about protecting the powerful by using psychiatrists' powers to detain patients under the Mental Health Act. Its real innovation is to marry crime prevention with a new way of finding and helping those with therapeutic needs: 'This is an area where the interests of security and public health overlap,' James says. 'We're not just providing protection: we're helping to find care and treatment for those whose lives are being destroyed by untreated mental illness.' Some of the patients first identified by FTAC, James says, are now leading 'functional and relatively normal' lives.

Only one British prime minister has ever been assassinated - Spencer Perceval, who was shot through the heart in the lobby of the House of Commons in May 1812. His killer, John Bellingham, was tried, sentenced and hanged within the week. His was an early example of the type of case that now, James hopes, would be picked up by FTAC.

Bellingham's obsessive pursuit of what he saw as 'justice' began when he was imprisoned in the port of Archangel, for an unpaid debt of 2,000 roubles he owed to some Russian merchants. Lord Granville Leveson-Gower, the British ambassador, eventually secured his release. But Bellingham, who returned to Britain in 1809, accused Leveson-Gower of 'culpable misconduct' in failing to protect him from the Russian authorities. Over the next three years, Bellingham petitioned parliament and sought compensation from several government ministers, but to no avail. Finally, he composed an archetypal end-of-the-road letter, to the police magistrates of Bow Street. 'I consider His Majesty's Government to have completely endeavoured to close the door of justice,' it said. 'Should this reasonable request be finally denied, I shall then feel justified in executing justice myself.'

Afterwards, Bellingham presented himself at the Treasury, where he warned officials that he now considered he had 'carte blanche' to exact whatever revenge he chose. He started visiting the Commons, watching where ministers sat in order to recognise them. Finally, having purchased two pistols and a greatcoat in which to conceal them, he lay in wait by the doors to the debating chamber, shooting Perceval as he approached.

'Bellingham had a lot in common with more modern cases,' James says. 'He saw the government's refusal to redress his grievance as the working of a conspiracy. The world for him was black or white: it had no shades of grey. And having tried every legitimate avenue, he thought he had no choice but to do what he was driven to, and that it was right.'

Before the establishment of FTAC, James, together with FTAC psychologist Lulu Preston and a team of international academics, began a series of studies of 'fixated' people such as Bellingham - a condition James defines as 'obsessive preoccupations pursued to an irrational and pathological degree'. His unit's sources include thousands of letters stored in police archives, security agency records in the UK and abroad, and official files on 24 non-terrorist violent attacks on politicians in Europe since 1990. FTAC has found some striking patterns. Of the 24 attacks, James says, five involved deaths (two of them were mass murders), while another eight led to serious injuries. About half of the assailants were clearly psychotic; most of the rest were either drunk (four) or politically motivated. However, it was the mentally disordered who were responsible for most of the fatal incidents and serious injuries, and most had given warnings which had gone unrecognised.

One of the worst took place on 27 September 2001, when a 57-year-old salesman named Friedrich Leibacher walked into the regional parliament chamber in the Swiss canton of Zug, armed with an assault rifle, an automatic pistol, a revolver and a pump-action shotgun. In the ensuing mayhem, he killed 14 people and badly wounded a further 15, before turning one of his weapons on himself.

The cause of his bloody spree was a dispute going back to 1998, when he had an altercation with a bus driver, Bert Betschart, who told him - wrongly, Leibacher claimed - that he could smell alcohol on his breath. It was the start of an escalating campaign, in which Leibacher complained about Betschart to the transport authorities, threatened him with a gun in a restaurant, and wrote ever more extravagant letters of complaint to officials and public figures. Finally the canton sued Leibacher for defamation, while he filed various countersuits against both Betschart and the authorities. On the day before the shooting, seven of his cases had been thrown out of court.

Vexatious, no-hope legal actions, James says, are often 'a very bad sign'. They formed part of the background to the murder of Andrew Pennington, an assistant to Nigel Jones, the Liberal Democrat MP for Cheltenham, who was run through six times with a samurai sword at Jones's surgery in January 2000. Pennington's killer, Robert Ashman, 50, was a water company official who had been made redundant, then lost his home and marriage, only to become convinced that he was the victim of a conspiracy between Lloyds-TSB, Cheltenham council, the Gloucestershire chief constable and the Inland Revenue.

Like Leibacher, Ashman had launched numerous law suits against those he saw as his tormentors, and in the eight years before he killed Jones's assistant he had visited his surgery between 50 and 100 times. His propensity to commit violence when he thought he was in the right was already well-established: in 1992 he had broken the ribs of a council tax collector when served with a legal summons for non-payment. On that occasion he avoided a jail sentence - thanks in part to a letter to the court from Nigel Jones, who stated the attack was 'out of character'.

Another murderer who slipped through the net was Richard Durn, whose case is one of the 24 on file at FTAC. In March 2002, Durn, a 33-year-old Parisian, killed eight councillors and wounded 19 as they sat through a late-night meeting in the town hall at Nanterre, in Paris. Durn, who a day later leapt to his death from the window of a police station, had told local Green councillors that 'there was a problem with democracy at the town hall'. What troubled many in France was the fact that Durn had been receiving psychiatric treatment for 20 years, and had previously threatened a doctor with a firearm, yet as the member of a gun club he was in legal possession of the two Glock semi-automatic pistols and the .357 Magnum he used to kill his victims.

Some of the perpetrators James has studied were highly delusional. Adelheid Streidel, who stabbed the then Saarland prime minister and Germany's future finance minister Oskar Lafontaine in April 1990 and so consigned him to a wheelchair for life, believed that Jesus Christ had ordered her to expose a secret network of 'killing factories', where abducted victims were dismembered and new beings fashioned from their body parts. If she could not bring the truth to light by public demonstrations, Streidel thought Jesus wanted her to 'kill a politician'.

In the same year, a schizophrenic named Dieter Kaufmann shot the German interior minister Wolfgang Schauble at a political rally, inflicting injuries that confined him to a wheelchair. Kaufmann had for seven years complained of government transmitters torturing him by transmitting pain into his body. He had spent years writing letters of complaint, had been to his MP and had twice tried to take legal action against the government. But no one had taken any notice. In the end, he could stand it no longer and felt driven to take matters into his own hands.

Mijailo Mijailovic, 25, also had a long history of paranoid psychosis. The unemployed son of Serbian immigrants, he murdered the Swedish foreign minister Anna Lindh in a Stockholm shopping mall in September 2003. An obsessive-compulsive who had to count the tiles in a toilet before he could leave, he had complained of hearing voices and had 'morbid thoughts about politicians', a group he saw as representative of a society that had rejected him. In prison, he became convinced that Tom Cruise was his brother and would 'help me find a girl'. After several months on anti-psychotic medication, his condition markedly improved.

In studying 23 attacks on the British royal family between 1778 and 2003, James and his colleagues found similar evidence of fixation and psychosis. One of the most notorious cases was the attempted kidnapping of Princess Anne from her car in the Mall in 1974, in which Ian Ball, 26, shot and wounded four people, including her chauffeur and bodyguard. A chronic schizophrenic, Ball is still in Broadmoor. Of those who threatened the royals, James says, 39 per cent stated they had 'reached a position of last resort'. Almost all these cases, both political and royal, shared three common factors, says James: 'The perpetrators were fixated. Information was coming in, but there was no system to assess it. And the attacks were potentially preventable.'

Media coverage of FTAC to date has portrayed it as something akin to the psychiatric hospitals used to lock up dissidents in the Soviet Union. In the Mail on Sunday's words, it is 'Blair's Secret Stalker Squad', armed with 'sweeping powers to check more than 10,000 suspects' files', and the ability to 'legally detain people for an indefinite period without trial, criminal charges, or even evidence of a crime having been committed and with very limited rights of appeal'. The truth is both less dramatic and more interesting.

At the heart of its psychiatric department are three senior forensic mental health nurses, who work with James and other part-time psychiatrists and psychologists. All bear in mind one of the overriding lessons from the studies of past attacks - that warning letters and other signals do not usually consist of threats to a specified individual, but, as James puts it, 'broader evidence of gross disturbance and psychopathology'. The letter to the prominent Tory MP made no threat to kill him - but stated that 'someone' had to die.

Often, says Robbie Forfar, FTAC's head nurse, spotting such warnings from the hundreds of communications now being referred by bodies such as the Royal Household and the Palace of Westminster is not hugely difficult. Concealing the names of those to whom they relate, he shows me details of some recent cases: a man who believes he has been the target of a hostile campaign by MI5 for many years; another whose letters to a prince about the 'mind machine' that controls him are getting steadily angrier and more bitter; a third who left his car illegally parked outside a government building, saying when challenged he had a message from God for Prince Charles. (Inside the vehicle was an authentic-looking imitation weapon. Police later found swords and airguns when they visited him at home.)

Such individuals may pose a much greater threat to themselves than to others. Elad Shetreet, who sprinkled fake anthrax into the Commons during Prime Minister's questions as part of his ongoing battle to prove that his Sharp TV set produces toxic fumes, told interrogators after his arrest that he wanted to get himself shot on international television.

'There have been cases of people showing up at public buildings dressed in combat fatigues, armed with fake weapons,' Forfar says. 'Given the current security climate, they are putting themselves at serious risk.'

FTAC's mental health staff don't just provide analysis, however. Because doctors can talk to doctors, it means that James and his colleagues can establish whether the letter-writers and others who come to their notice have already been receiving treatment, overcoming what would otherwise be insuperable barriers of patient confidentiality. And, most important, it allows the unit to refer those who come to its attention to their local mental health services.

Meanwhile, FTAC's cops - six PCs, an intelligence analyst and a detective sergeant, led by Detective Inspector Tom Kerrigan and the unit's co-director, DCI Bob Garratt - make enquiries into subjects' backgrounds. A past record of violence will, of course, be of particular concern. Often, Forfar and one of the PCs will visit someone together, to assess their level of threat: 'We try to persuade them to get help. We try to build a rapport,' he says.

All this may well reduce the overall risk of attack. But according to James, it has a still more valuable function. At least half of the approximately 200 cases FTAC has dealt with were completely unknown to the mental health services, or had ceased all treatment for previous illness long ago. 'What we're doing is putting pieces of the jigsaw together that were previously held separately,' James says. 'We are discovering people who are extremely ill, but who have fallen out of the networks of care. FTAC plugs them back in. We have found a new way of getting help to people whose lives are literally being ruined by their delusions and fixations. We're getting them back in touch with their families, and giving them the means to reclaim a functional life.'

Of the cases FTAC has referred - it does not, James stresses, have any vaunted 'sweeping powers' to section people on its own - 40 per cent have been admitted to hospital, at least initially, and slightly fewer treated as outpatients, including the man who wrote to the Tory MP that 'someone is going to have to die'. Some 6.5 per cent were dealt with at court, having come to FTAC's attention after being charged. The rest either disappeared or left the country. Of those who received treatment, almost all have avoided trouble with the law: as a means of preventing crime, FTAC is unusually successful.

There has been a further, unexpected benefit. Psychotic people who communicate with politicians may already be causing other kinds of trouble. One man, mired in a complex delusion that linked his unjust eviction from a previous flat, 'Nazi' royals and global political events, turned out quite separately to be stalking a woman who lived nearby. When the police searched his home, they found hundreds of pornographic, threatening letters. 'We had him sectioned. He was seriously ill,' James says, 'but he responded well to treatment. Now he's in remission, back in the community and the threat to this woman appears to be lifted.'

In another case, a man from Wales made repeated and bizarre attempts to contact the Duke of Edinburgh. FTAC's investigations established that he had two convictions for rape and a psychiatric history. He was living in a hostel where staff were becoming seriously concerned by his highly sexualised behaviour: 'He had raped before when he was ill, and he was starting to relapse.' When he started back on medication, both the approaches to Prince Philip and the sexualised behaviour stopped.

Identifying the mentally ill through their communications with royals could, says James, prevent serious crimes. On 7 March 1996, the Queen received a letter from a man who wrote that he felt ostracised from his fellow men, an injustice that she could right: 'I turn to you as a last resort and am appealing, for I may be able to regain my self-esteem in society.' His name was Thomas Hamilton. The following week, he killed 16 children and a teacher, and then shot himself, at a primary school in Dunblane.

For FTAC's police officers, says Bob Garratt, the unit 'is unlike anything we've ever done before. In normal police work you research a suspect when a crime has taken place. By definition, the people we're dealing with have usually not committed an offence.' Also, he adds, 'Police officers often talk of coming across people with "harmless delusions". They may not be harmless at all. What the officers mean is because their sufferers aren't acting on their delusions violently at that moment, they have no powers. People have to be behaving very bizarrely indeed before the police can take action under the Mental Health Act.'

Putting the police in the same office as mental health staff has a big impact, according to Garratt: 'Instead of trying to get people punished, and potentially stigmatising them, the police are part of the service that can help.'

Co-locating police and mental health services may in time bring benefits that extend well beyond those people fixated on politicians and royals. 'Diversion' - keeping mentally ill offenders out of the criminal justice system - is a long-held government ambition, one to which James has devoted a substantial part of his career. It is also one that has, for the most part, failed, and numerous studies have revealed that thousands of prisoners in the UK have a serious mental illness.

Could the approach pioneered through FTAC - the identification of those with a psychiatric illness before they offend - have wider application? Garratt and James believe so. 'We could be setting up local, mini-FTACs,' Garratt says, with mental health staff working much more closely with police intelligence units, perhaps even listening to the messages that come through control rooms.

'Only a few years ago, when the police came across a case of domestic violence, we would treat it as something that didn't concern us,' Garratt says. 'Such an attitude now would be unthinkable. A little bit later we made an analogous change in our attitude to homophobic crime. Maybe the time is coming,' he says, 'for a similar shift in the way we deal with mental illness - and FTAC could be the start.'

does this mean they can access your notes even though your not their patient?

August 26 2007, 8:53 PM

FTAC's mental health staff don't just provide analysis, however. Because doctors can talk to doctors, it means that James and his colleagues can establish whether the letter-writers and others who come to their notice have already been receiving treatment, overcoming what would otherwise be insuperable barriers of patient confidentiality. And, most important, it allows the unit to refer those who come to its attention to their local mental health services.

found a new way of getting help to people whose lives are being ruined by delusions

August 26 2007, 8:55 PM

FTAC plugs them back in. We have found a new way of getting help to people whose lives are literally being ruined by their delusions and fixations. We're getting them back in touch with their families, and giving them the means to reclaim a functional life.'

a deluded person

comming to you soon .....your own local mini FTAC

August 26 2007, 9:03 PM

Could the approach pioneered through FTAC - the identification of those with a psychiatric illness before they offend - have wider application? Garratt and James believe so. 'We could be setting up local, mini-FTACs,' Garratt says, with mental health staff working much more closely with police intelligence units, perhaps even listening to the messages that come through control rooms.

'Only a few years ago, when the police came across a case of domestic violence, we would treat it as something that didn't concern us,' Garratt says. 'Such an attitude now would be unthinkable. A little bit later we made an analogous change in our attitude to homophobic crime. Maybe the time is coming,' he says, 'for a similar shift in the way we deal with mental illness - and FTAC could be the start.'

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